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Review
. 2020 Jan;43(1):3-9.
doi: 10.1080/10790268.2018.1474692. Epub 2018 May 21.

Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations - a historical analysis in the era of modern spinal surgery

Affiliations
Review

Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations - a historical analysis in the era of modern spinal surgery

Andrei Fernandes Joaquim et al. J Spinal Cord Med. 2020 Jan.

Abstract

Context: It is well established that traumatic spinal dislocations (AO Type C injuries) should be surgically treated. However, no recent comparative study of surgical versus non-surgical management of type C injuries was found attesting the superiority of surgical treatment.Objective: Due to the lack of information about the natural history of non-surgical management of type C injuries, we evaluated the outcome of historical conservative treatment of type C injuries.Methods: An extensive manual search of articles was performed in the Pubmed Database. We included articles that reported the clinical and/ or the radiological outcome of non-surgical management of thoracic and/ or lumbar spinal fracture-dislocations.Results: Three well described retrospective studies where fracture-dislocations of the thoracolumbar spine were managed non-surgically were included. Non-surgical management typically consisted in postural reduction and prolonged bed rest (about 10-13 weeks on average). Residual deformity was common, and some studies reported a high rate of post treatment pain syndromes. Some studies reported surgery for gibbus deformity after conservative treatment or persistent instability requiring further bed rest. Neurological deterioration was rare, and some patients had some improvement, although the vast majority of the patients had persistent, severe neurological deficits.Conclusions: Compared with historical non-surgical care, surgery for type C injuries decreases the chances of post-operative pain, late spinal deformity and also allowed early rehabilitation, once no bed restriction is necessary. Ethical issues based on this historical analysis may preclude performing a comparative study of non-surgical versus surgical management of these injuries in the modern spine era.

Keywords: Dislocations; Fracture; Fracture-dislocations; Paraplegia; Spinal fracture; Treatment; Vertebral injury.

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References

    1. Joaquim AF, Patel AA.. Thoracolumbar Spine Trauma: Evaluation and Surgical Decision Making. J Craniovert Jun Spine 2013;4(1):3–9 doi: 10.4103/0974-8237.121616 - DOI - PMC - PubMed
    1. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. . AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 2013;38(23):2028–37. doi: 10.1097/BRS.0b013e3182a8a381 - DOI - PubMed
    1. Vaccaro AR, Zeiller SC, Hulbert RJ, Anderson Pa, Harris M, Hedlund R, et al. . The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 2005;18(3):209–15 - PubMed
    1. Joaquim AF, Ghizoni E, Tedeschi H, Batista UC, Patel AA.. Clinical Results of Patients with Thoracolumbar Spine Trauma Treated According to the Thoracolumbar Injury Classification System and Severity Score. J Neurosurg Spine 2014; 20(5):562–7. doi: 10.3171/2014.2.SPINE121114 - DOI - PubMed
    1. Xiong W, Li F, Zhang F, Huo X, Chen A.. Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series. Turk Neurosurg 2013;23(2):170–8. - PubMed

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